The impact of an intervention to reduce dispersal from wastewater drain sites on carbapenem-resistant Pseudomonas aeruginosa colonization and bloodstream infection on a hematopoietic cell transplant and hematologic malignancy unit.
Infect Control Hosp Epidemiol
; 45(7): 847-855, 2024 Jul.
Article
en En
| MEDLINE
| ID: mdl-38385257
ABSTRACT
OBJECTIVE:
To evaluate the impact of an intervention to limit dispersal from wastewater drain (WWD) sites on meropenem-nonsusceptible Pseudomonas aeruginosa patient and environmental colonization and bloodstream infection (BSI) on a hematopoietic cell transplant (HCT) and hematologic malignancy (HM) unit.DESIGN:
This quasi-experimental study included pre/postintervention point-prevalence surveys in July 2019 and June 2020, respectively. The retrospective cohort included HCT/HM patients with P. aeruginosa BSI between 2012 and 2022.SETTING:
Adult HCT/HM unit at an academic center.PARTICIPANTS:
This study included consenting HCT/HM patients on the unit at the time of the point-prevalence surveys. HCT/HM patients with P. aeruginosa BSI between 2012 and 2022.METHODS:
A quality improvement intervention targeting WWD sites was conceived and implemented on a HCT/HM unit. Pre and postintervention colonization samples were obtained from patients and environmental sites, cultivated on selective media, then characterized by susceptibility testing. Whole-genome sequencing and phylogenetic analysis were performed on select isolates. The impact of the intervention on colonization and BSI was evaluated, as was relatedness among isolates.RESULTS:
Although colonization of WWD sites with meropenem-nonsusceptible P. aeruginosa was widespread before and after this intervention, we observed a substantial decline in patient colonization (prevalence rate ratio, 0.35; 95% confidence interval [CI], 0.04-3.12) and BSI (incidence rate ratio, 0.67; 95% CI, 0.31-1.42) after the intervention. Among 3 predominant sequence types (ST-111, ST-446, and ST-308), there was striking genetic conservation within groups and among environmental colonization, patient colonization, and BSI isolates.CONCLUSIONS:
An intervention targeting WWD sites on a HCT/HM unit had a meaningful impact on meropenem-nonsusceptible P. aeruginosa patient colonization and BSI.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Pseudomonas aeruginosa
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Infecciones por Pseudomonas
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Trasplante de Células Madre Hematopoyéticas
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Neoplasias Hematológicas
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Aguas Residuales
Límite:
Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Infect Control Hosp Epidemiol
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Infect. control hosp. epidemiol
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Infection control and hospital epidemiology
Asunto de la revista:
DOENCAS TRANSMISSIVEIS
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ENFERMAGEM
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EPIDEMIOLOGIA
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HOSPITAIS
Año:
2024
Tipo del documento:
Article